|
HC INJ LUMB W MYELO CERV SAME MD
|
Facility
|
IP
|
$2,248.62
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
36100460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,416.63 |
| Max. Negotiated Rate |
$2,023.76 |
| Rate for Payer: Aetna Commercial |
$1,911.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cofinity Advantage |
$1,574.03
|
| Rate for Payer: Cofinity Commercial |
$1,933.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,798.90
|
| Rate for Payer: Healthscope Commercial |
$2,023.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,911.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,686.46
|
| Rate for Payer: PHP Commercial |
$1,911.33
|
| Rate for Payer: Priority Health SBD |
$1,416.63
|
|
|
HC INJ LUMB W MYELO LS SAME MD
|
Facility
|
OP
|
$2,248.62
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
36100462
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,526.00 |
| Rate for Payer: Aetna Commercial |
$1,911.33
|
| Rate for Payer: Aetna Medicare |
$812.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,461.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$592.30
|
| Rate for Payer: BCN Commercial |
$592.30
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cofinity Advantage |
$1,574.03
|
| Rate for Payer: Cofinity Commercial |
$1,933.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,798.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$2,023.76
|
| Rate for Payer: Mclaren Medicaid |
$408.52
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$820.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,911.33
|
| Rate for Payer: Nomi Health Commercial |
$2,343.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,686.46
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$1,911.33
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,526.00
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health SBD |
$1,416.63
|
| Rate for Payer: Priority Health Tiered Network |
$2,020.80
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC INJ LUMB W MYELO LS SAME MD
|
Facility
|
IP
|
$2,248.62
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
36100462
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,416.63 |
| Max. Negotiated Rate |
$2,023.76 |
| Rate for Payer: Aetna Commercial |
$1,911.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cofinity Advantage |
$1,574.03
|
| Rate for Payer: Cofinity Commercial |
$1,933.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,798.90
|
| Rate for Payer: Healthscope Commercial |
$2,023.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,911.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,686.46
|
| Rate for Payer: PHP Commercial |
$1,911.33
|
| Rate for Payer: Priority Health SBD |
$1,416.63
|
|
|
HC INJ LUMB W MYELO THOR SAME MD
|
Facility
|
OP
|
$2,248.62
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
36100461
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.74 |
| Max. Negotiated Rate |
$2,526.00 |
| Rate for Payer: Aetna Commercial |
$1,911.33
|
| Rate for Payer: Aetna Medicare |
$812.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,461.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$308.74
|
| Rate for Payer: BCN Commercial |
$308.74
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cofinity Advantage |
$1,574.03
|
| Rate for Payer: Cofinity Commercial |
$1,933.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,798.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$2,023.76
|
| Rate for Payer: Mclaren Medicaid |
$408.52
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$820.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,911.33
|
| Rate for Payer: Nomi Health Commercial |
$2,343.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,686.46
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$1,911.33
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,526.00
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health SBD |
$1,416.63
|
| Rate for Payer: Priority Health Tiered Network |
$2,020.80
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC INJ LUMB W MYELO THOR SAME MD
|
Facility
|
IP
|
$2,248.62
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
36100461
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,416.63 |
| Max. Negotiated Rate |
$2,023.76 |
| Rate for Payer: Aetna Commercial |
$1,911.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cofinity Advantage |
$1,574.03
|
| Rate for Payer: Cofinity Commercial |
$1,933.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,798.90
|
| Rate for Payer: Healthscope Commercial |
$2,023.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,911.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,686.46
|
| Rate for Payer: PHP Commercial |
$1,911.33
|
| Rate for Payer: Priority Health SBD |
$1,416.63
|
|
|
HC INJ LYMPHANGIOGRAPHY
|
Facility
|
IP
|
$1,331.27
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
36100445
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$838.70 |
| Max. Negotiated Rate |
$1,198.14 |
| Rate for Payer: Aetna Commercial |
$1,131.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$865.33
|
| Rate for Payer: Cash Price |
$1,065.02
|
| Rate for Payer: Cofinity Advantage |
$931.89
|
| Rate for Payer: Cofinity Commercial |
$1,144.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,065.02
|
| Rate for Payer: Healthscope Commercial |
$1,198.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,131.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$998.45
|
| Rate for Payer: PHP Commercial |
$1,131.58
|
| Rate for Payer: Priority Health SBD |
$838.70
|
|
|
HC INJ LYMPHANGIOGRAPHY
|
Facility
|
OP
|
$1,331.27
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
36100445
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$222.90 |
| Max. Negotiated Rate |
$1,198.14 |
| Rate for Payer: Aetna Commercial |
$1,131.58
|
| Rate for Payer: Aetna Medicare |
$665.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$865.33
|
| Rate for Payer: BCBS Complete |
$532.51
|
| Rate for Payer: BCBS Trust/PPO |
$222.90
|
| Rate for Payer: BCN Commercial |
$222.90
|
| Rate for Payer: Cash Price |
$1,065.02
|
| Rate for Payer: Cash Price |
$1,065.02
|
| Rate for Payer: Cofinity Advantage |
$931.89
|
| Rate for Payer: Cofinity Commercial |
$1,144.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,065.02
|
| Rate for Payer: Healthscope Commercial |
$1,198.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,131.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$998.45
|
| Rate for Payer: PHP Commercial |
$1,131.58
|
| Rate for Payer: Priority Health SBD |
$838.70
|
|
|
HC INJ, METHYLPREDNISOLONE ACETATE, 1 MG
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
63600239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna Commercial |
$0.45
|
| Rate for Payer: Aetna Medicare |
$0.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.34
|
| Rate for Payer: BCBS Complete |
$0.21
|
| Rate for Payer: BCBS Trust/PPO |
$0.30
|
| Rate for Payer: BCN Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cofinity Advantage |
$0.37
|
| Rate for Payer: Cofinity Commercial |
$0.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.42
|
| Rate for Payer: Healthscope Commercial |
$0.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.40
|
| Rate for Payer: PHP Commercial |
$0.45
|
| Rate for Payer: Priority Health SBD |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
|
|
HC INJ, METHYLPREDNISOLONE ACETATE, 1 MG
|
Facility
|
IP
|
$0.53
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
63600239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Aetna Commercial |
$0.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.34
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cofinity Advantage |
$0.37
|
| Rate for Payer: Cofinity Commercial |
$0.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.42
|
| Rate for Payer: Healthscope Commercial |
$0.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.40
|
| Rate for Payer: PHP Commercial |
$0.45
|
| Rate for Payer: Priority Health SBD |
$0.33
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, 5 MG
|
Facility
|
IP
|
$2.65
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
63600240
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.72
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Advantage |
$1.85
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.99
|
| Rate for Payer: PHP Commercial |
$2.25
|
| Rate for Payer: Priority Health SBD |
$1.67
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, 5 MG
|
Facility
|
OP
|
$2.65
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
63600240
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.72
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Advantage |
$1.85
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.99
|
| Rate for Payer: PHP Commercial |
$2.25
|
| Rate for Payer: Priority Health SBD |
$1.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.43
|
| Rate for Payer: UHC Core |
$0.43
|
| Rate for Payer: UHC Exchange |
$0.43
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 125MG
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
63600102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.27
|
| Rate for Payer: UHC Core |
$13.27
|
| Rate for Payer: UHC Exchange |
$13.27
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 125MG
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
63600102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 40MG
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
63600101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 40MG
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
63600101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.49 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$10.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.62
|
| Rate for Payer: UHC Core |
$10.62
|
| Rate for Payer: UHC Exchange |
$10.62
|
|
|
HC INJ NERV BLOCK GREAT OCCIPTL
|
Facility
|
IP
|
$404.50
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
36100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.84 |
| Max. Negotiated Rate |
$364.05 |
| Rate for Payer: Aetna Commercial |
$343.82
|
| Rate for Payer: Aetna Commercial |
$229.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.29
|
| Rate for Payer: Cash Price |
$215.74
|
| Rate for Payer: Cash Price |
$323.60
|
| Rate for Payer: Cofinity Advantage |
$283.15
|
| Rate for Payer: Cofinity Advantage |
$188.77
|
| Rate for Payer: Cofinity Commercial |
$231.92
|
| Rate for Payer: Cofinity Commercial |
$347.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.74
|
| Rate for Payer: Healthscope Commercial |
$364.05
|
| Rate for Payer: Healthscope Commercial |
$242.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.38
|
| Rate for Payer: PHP Commercial |
$229.22
|
| Rate for Payer: PHP Commercial |
$343.82
|
| Rate for Payer: Priority Health SBD |
$254.84
|
| Rate for Payer: Priority Health SBD |
$169.89
|
|
|
HC INJ NERV BLOCK GREAT OCCIPTL
|
Facility
|
OP
|
$404.50
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
36100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.97 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Commercial |
$343.82
|
| Rate for Payer: Aetna Commercial |
$229.22
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$224.17
|
| Rate for Payer: BCBS Trust/PPO |
$224.17
|
| Rate for Payer: BCN Commercial |
$224.17
|
| Rate for Payer: BCN Commercial |
$224.17
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$323.60
|
| Rate for Payer: Cash Price |
$215.74
|
| Rate for Payer: Cash Price |
$215.74
|
| Rate for Payer: Cash Price |
$323.60
|
| Rate for Payer: Cash Price |
$323.60
|
| Rate for Payer: Cash Price |
$215.74
|
| Rate for Payer: Cofinity Advantage |
$188.77
|
| Rate for Payer: Cofinity Advantage |
$283.15
|
| Rate for Payer: Cofinity Commercial |
$347.87
|
| Rate for Payer: Cofinity Commercial |
$231.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$364.05
|
| Rate for Payer: Healthscope Commercial |
$242.70
|
| Rate for Payer: Mclaren Medicaid |
$159.96
|
| Rate for Payer: Mclaren Medicaid |
$159.96
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.82
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.38
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$229.22
|
| Rate for Payer: PHP Commercial |
$343.82
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health SBD |
$254.84
|
| Rate for Payer: Priority Health SBD |
$169.89
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.29
|
| Rate for Payer: UHC Core |
$140.50
|
| Rate for Payer: UHC Core |
$210.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$105.98
|
| Rate for Payer: UHC Exchange |
$158.97
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC INJ ONABOTULINUMTOXINA PER 1 UNIT
|
Facility
|
OP
|
$8.32
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$20.50 |
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: Aetna Medicare |
$6.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.14
|
| Rate for Payer: BCBS Complete |
$3.58
|
| Rate for Payer: BCBS MAPPO |
$6.51
|
| Rate for Payer: BCBS Trust/PPO |
$16.33
|
| Rate for Payer: BCN Commercial |
$16.33
|
| Rate for Payer: BCN Medicare Advantage |
$6.51
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Advantage |
$5.82
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.51
|
| Rate for Payer: Healthscope Commercial |
$7.49
|
| Rate for Payer: Mclaren Medicaid |
$3.40
|
| Rate for Payer: Mclaren Medicare |
$6.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.84
|
| Rate for Payer: Meridian Medicaid |
$6.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: Nomi Health Commercial |
$19.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.24
|
| Rate for Payer: PACE Medicare |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.51
|
| Rate for Payer: PHP Commercial |
$7.07
|
| Rate for Payer: PHP Medicare Advantage |
$6.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20.50
|
| Rate for Payer: Priority Health Medicare |
$6.51
|
| Rate for Payer: Priority Health SBD |
$5.24
|
| Rate for Payer: Priority Health Tiered Network |
$16.40
|
| Rate for Payer: Railroad Medicare Medicare |
$6.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.16
|
| Rate for Payer: UHC Core |
$7.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.51
|
| Rate for Payer: UHC Exchange |
$7.16
|
| Rate for Payer: UHC Medicaid |
$3.40
|
| Rate for Payer: UHCCP Medicaid |
$3.40
|
| Rate for Payer: VA VA |
$6.51
|
|
|
HC INJ ONABOTULINUMTOXINA PER 1 UNIT
|
Facility
|
IP
|
$8.32
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.41
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Advantage |
$5.82
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Healthscope Commercial |
$7.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.24
|
| Rate for Payer: PHP Commercial |
$7.07
|
| Rate for Payer: Priority Health SBD |
$5.24
|
|
|
HC INJ PEN G BENZATHINE/PROCAINE 100,000 UNITS
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$61.59 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare |
$20.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.40
|
| Rate for Payer: BCBS Complete |
$10.72
|
| Rate for Payer: BCBS MAPPO |
$19.52
|
| Rate for Payer: BCBS Trust/PPO |
$48.98
|
| Rate for Payer: BCN Commercial |
$48.98
|
| Rate for Payer: BCN Medicare Advantage |
$19.52
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Advantage |
$42.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.52
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Mclaren Medicaid |
$10.21
|
| Rate for Payer: Mclaren Medicare |
$19.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.50
|
| Rate for Payer: Meridian Medicaid |
$20.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.00
|
| Rate for Payer: Nomi Health Commercial |
$58.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.00
|
| Rate for Payer: PACE Medicare |
$18.54
|
| Rate for Payer: PACE SWMI |
$19.52
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: PHP Medicare Advantage |
$19.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$61.59
|
| Rate for Payer: Priority Health Medicare |
$19.52
|
| Rate for Payer: Priority Health SBD |
$37.80
|
| Rate for Payer: Priority Health Tiered Network |
$49.27
|
| Rate for Payer: Railroad Medicare Medicare |
$19.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.21
|
| Rate for Payer: UHC Core |
$32.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.52
|
| Rate for Payer: UHC Exchange |
$32.21
|
| Rate for Payer: UHC Medicaid |
$10.21
|
| Rate for Payer: UHCCP Medicaid |
$10.21
|
| Rate for Payer: VA VA |
$19.52
|
|
|
HC INJ PEN G BENZATHINE/PROCAINE 100,000 UNITS
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Advantage |
$42.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health SBD |
$37.80
|
|
|
HC INJ, PENICILLIN G BENZATHINE, 100,000 UNITS
|
Facility
|
OP
|
$17.52
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$94.66 |
| Rate for Payer: Aetna Commercial |
$14.89
|
| Rate for Payer: Aetna Medicare |
$32.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.34
|
| Rate for Payer: BCBS Complete |
$17.28
|
| Rate for Payer: BCBS MAPPO |
$31.47
|
| Rate for Payer: BCBS Trust/PPO |
$83.35
|
| Rate for Payer: BCN Commercial |
$83.35
|
| Rate for Payer: BCN Medicare Advantage |
$31.47
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cofinity Advantage |
$12.26
|
| Rate for Payer: Cofinity Commercial |
$15.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$15.77
|
| Rate for Payer: Mclaren Medicaid |
$16.46
|
| Rate for Payer: Mclaren Medicare |
$31.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.04
|
| Rate for Payer: Meridian Medicaid |
$33.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.89
|
| Rate for Payer: Nomi Health Commercial |
$94.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.14
|
| Rate for Payer: PACE Medicare |
$29.90
|
| Rate for Payer: PACE SWMI |
$31.47
|
| Rate for Payer: PHP Commercial |
$14.89
|
| Rate for Payer: PHP Medicare Advantage |
$31.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$94.66
|
| Rate for Payer: Priority Health Medicare |
$31.47
|
| Rate for Payer: Priority Health SBD |
$11.04
|
| Rate for Payer: Priority Health Tiered Network |
$75.73
|
| Rate for Payer: Railroad Medicare Medicare |
$31.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.75
|
| Rate for Payer: UHC Core |
$52.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.47
|
| Rate for Payer: UHC Exchange |
$52.75
|
| Rate for Payer: UHC Medicaid |
$16.46
|
| Rate for Payer: UHCCP Medicaid |
$16.46
|
| Rate for Payer: VA VA |
$31.47
|
|
|
HC INJ, PENICILLIN G BENZATHINE, 100,000 UNITS
|
Facility
|
IP
|
$17.52
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$15.77 |
| Rate for Payer: Aetna Commercial |
$14.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.39
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cofinity Advantage |
$12.26
|
| Rate for Payer: Cofinity Commercial |
$15.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.02
|
| Rate for Payer: Healthscope Commercial |
$15.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.14
|
| Rate for Payer: PHP Commercial |
$14.89
|
| Rate for Payer: Priority Health SBD |
$11.04
|
|
|
HC INJ PROCHLORPERAZINE UP TO 10 MG
|
Facility
|
OP
|
$79.78
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
63600246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$71.80 |
| Rate for Payer: Aetna Commercial |
$67.81
|
| Rate for Payer: Aetna Medicare |
$39.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.86
|
| Rate for Payer: BCBS Complete |
$31.91
|
| Rate for Payer: BCBS Trust/PPO |
$6.30
|
| Rate for Payer: BCN Commercial |
$6.30
|
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Cofinity Advantage |
$55.85
|
| Rate for Payer: Cofinity Commercial |
$68.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.82
|
| Rate for Payer: Healthscope Commercial |
$71.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.84
|
| Rate for Payer: PHP Commercial |
$67.81
|
| Rate for Payer: Priority Health SBD |
$50.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.16
|
| Rate for Payer: UHC Core |
$4.16
|
| Rate for Payer: UHC Exchange |
$4.16
|
|
|
HC INJ PROCHLORPERAZINE UP TO 10 MG
|
Facility
|
IP
|
$79.78
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
63600246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.26 |
| Max. Negotiated Rate |
$71.80 |
| Rate for Payer: Aetna Commercial |
$67.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.86
|
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Cofinity Advantage |
$55.85
|
| Rate for Payer: Cofinity Commercial |
$68.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.82
|
| Rate for Payer: Healthscope Commercial |
$71.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.84
|
| Rate for Payer: PHP Commercial |
$67.81
|
| Rate for Payer: Priority Health SBD |
$50.26
|
|
